Purpose: The use of antibiotics for prophylaxis for elective surgeries is common practice among surgeons in an effort to prevent surgical site infections (SSIs). In many cases, the use of antibiotics is not only unnecessary, but also dangerous resulting in serious complications. The present study aims to assess the impact of antibiotic prophylaxis on SSIs.Methods: The Michigan Surgical Quality Collaborative Database was queried for patients undergoing elective abdominal wall reconstruction from 2013-2015. A logistic regression was performed to identify independent predictors for SSIs development and a composite score was created. The study population was divided in groups based on their score and the impact of pre- operative antibiotics was examined.Results: A total of 4,983 patients were identified. The incidence of SSIs was 3.35% (n=167). Based on the scoring system (table), two groups were identified regarding the development of SSI [low risk (<12), 0%-4% versus high risk (≥12), 7%-24%, p<0.05]. Pre-operative antibiotics had no impact on the development of SSIs for the low risk group [AOR (95% CI): 2.04 (0.64, 6.50)]. Interestingly, pre-operative antibiotics reduced the probability of SSIs development by 50% [AOR (95% CI): 0.51 (0.24, 0.78)].Conclusion: The proposed scoring system accurately predicts the development of SSIs in patients undergoing elective abdominal wall reconstruction. The use of the scoring system could guide the surgeon’s decision regarding administration of pre- operative antibiotics.